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Torres T, Chiricozzi A, Puig L, Lé AM, Marzano AV, Dapavo P, Dauden E, Carrascosa JM, Lazaridou E, Duarte G, Carvalho AVE, Romiti R, Rompoti N, Teixeira L, Abreu M, Ippoliti E, Maronese CA, Llamas-Velasco M, Vilarrasa E, Del Alcázar E, Daponte AI, Papoutsaki M, Carugno A, Bellinato F, Gisondi P. Treatment of Psoriasis Patients with Latent Tuberculosis Using IL-17 and IL-23 Inhibitors: A Retrospective, Multinational, Multicentre Study. Am J Clin Dermatol 2024; 25:333-342. [PMID: 38265746 PMCID: PMC10867072 DOI: 10.1007/s40257-024-00845-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Tuberculosis has a major global impact. Immunocompetent hosts usually control this disease, resulting in an asymptomatic latent tuberculosis infection (LTBI). Because TNF inhibitors increase the risk of tuberculosis reactivation, current guidelines recommend tuberculosis screening before starting any biologic drug, and chemoprophylaxis if LTBI is diagnosed. Available evidence from clinical trials and real-world studies suggests that IL-17 and IL-23 inhibitors do not increase the risk of tuberculosis reactivation. OBJECTIVE To evaluate psoriasis patients with treated or untreated newly diagnosed LTBI who received IL-17 and IL-23 inhibitors and the tolerability/safety of tuberculosis chemoprophylaxis. METHODS This is a retrospective, observational, multinational study from a series of 14 dermatology centres based in Portugal, Spain, Italy, Greece and Brazil, which included adult patients with moderate-to-severe chronic plaque psoriasis and newly diagnosed LTBI who were treated with IL-23 or IL-17 inhibitors between January 2015 and March 2022. LTBI was diagnosed in the case of tuberculin skin test and/or interferon gamma release assay positivity, according to local guideline, prior to initiating IL-23 or IL-17 inhibitor. Patients with prior diagnosis of LTBI (treated or untreated) or treated active infection were excluded. RESULTS A total of 405 patients were included; complete/incomplete/no chemoprophylaxis was administered in 62.2, 10.1 and 27.7% of patients, respectively. The main reason for not receiving or interrupting chemoprophylaxis was perceived heightened risk of liver toxicity and hepatotoxicity, respectively. The mean duration of biological treatment was 32.87 ± 20.95 months, and only one case of active tuberculosis infection (ATBI) was observed, after 14 months of treatment with ixekizumab. The proportion of ATBI associated with ixekizumab was 1.64% [95% confidence interval (CI): 0-5.43%] and 0% for all other agents and 0.46% (95% CI 0-1.06%) and 0% for IL-17 and IL-23 inhibitors, respectively (not statistically significant). CONCLUSIONS The risk of tuberculosis reactivation in patients with psoriasis and LTBI does not seem to increase with IL-17 or IL-23 inhibitors. IL-17 or IL-23 inhibitors should be preferred over TNF antagonists when concerns regarding tuberculosis reactivation exists. In patients with LTBI considered at high risk for developing complications related to chemoprophylaxis, this preventive strategy may be waived before initiating treatment with IL-17 inhibitors and especially IL-23 inhibitors.
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Affiliation(s)
- Tiago Torres
- Department of Dermatology, CAC ICBAS-CHP - Centro Académico Clínico ICBAS - CHP, Rua D. Manuel II, s/n, 4100, Porto, Portugal.
- UMIB - Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
| | - Andrea Chiricozzi
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ana Maria Lé
- Department of Dermatology, CAC ICBAS-CHP - Centro Académico Clínico ICBAS - CHP, Rua D. Manuel II, s/n, 4100, Porto, Portugal
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Paolo Dapavo
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - Esteban Dauden
- Department of Dermatology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa (IIS-IP), Madrid, Spain
| | - Jόse-Manuel Carrascosa
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - Elizabeth Lazaridou
- Second Department of Dermatology-Venereology, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Gleison Duarte
- Instituto Bahiano de Imunoterapias-IBIS, Salvador, Brazil
| | - André V E Carvalho
- Ambulatório de psoríase, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Ricardo Romiti
- Faculty of Medicine, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Natalia Rompoti
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Laetitia Teixeira
- UMIB - Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Miguel Abreu
- UMIB - Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
- Department of Infectious Diseases, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Elena Ippoliti
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa (IIS-IP), Madrid, Spain
| | - Eva Vilarrasa
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Elena Del Alcázar
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - Athina-Ioanna Daponte
- Second Department of Dermatology-Venereology, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Marina Papoutsaki
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Andrea Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University Hospital of Verona, Verona, Italy
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Lé AM, Nogueira M, Coelho A, Ferreira S. Rare cutaneous amyloid lesions as multiple myeloma presenting symptom. Int J Dermatol 2024; 63:e41-e43. [PMID: 38093406 DOI: 10.1111/ijd.16971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/17/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Ana Maria Lé
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Miguel Nogueira
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - André Coelho
- Pathology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Sandra Ferreira
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
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Luz M, Lé AM, Torres T. Risankizumab in the Management of Psoriasis in Solid Organ Transplant Recipients. Actas Dermosifiliogr 2024:S0001-7310(24)00054-1. [PMID: 38307168 DOI: 10.1016/j.ad.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/02/2023] [Accepted: 09/14/2023] [Indexed: 02/04/2024] Open
Affiliation(s)
- M Luz
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - A M Lé
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - T Torres
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
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Lé AM, Peixeiro R, Coelho A, Cabral R, Fernandes I. Subcutaneous panniculitis-like T-cell lymphoma: a case report. Eur J Dermatol 2023; 33:722-724. [PMID: 38465570 DOI: 10.1684/ejd.2023.4626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Affiliation(s)
- Ana Maria Lé
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Rita Peixeiro
- Department of Clinical Hematology, Centro Hospitalar Universitário de Santo António, Porto, Portugal, Multidisciplinary Consultation for Cutaneous Lymphomas and Mastocytosis, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - André Coelho
- Department of Pathology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Renata Cabral
- Department of Clinical Hematology, Centro Hospitalar Universitário de Santo António, Porto, Portugal, Multidisciplinary Consultation for Cutaneous Lymphomas and Mastocytosis, Centro Hospitalar Universitário de Santo António, Porto, Portugal, Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar
| | - Iolanda Fernandes
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal, Multidisciplinary Consultation for Cutaneous Lymphomas and Mastocytosis, Centro Hospitalar Universitário de Santo António, Porto, Portugal, Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar
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González DV, Rosell-Díaz ÁM, Chircop I, Lé AM, Dege T, Byrne N, Reynaud V, García-Piqueras P. Journal Club: Mycosis fungoides and Sézary syndrome: an update on a classic disease. Eur J Dermatol 2023; 33:714-718. [PMID: 38465567 DOI: 10.1684/ejd.2023.4623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Affiliation(s)
| | | | - Inès Chircop
- Department of Dermatology, Hôpital Edouard Herriot, Lyon, France, CIRI, Centre International de Recherche en Infectiologie, (Team Epidermal Immunity and Allergy); INSERM, U1111; Univ Lyon; Université de Lyon 1; École Normale Supérieure de Lyon; CNRS, UMR 5308, Lyon, France
| | - Ana Maria Lé
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Tassilo Dege
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Niamh Byrne
- Department of Dermatology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Victoire Reynaud
- CIRI, Centre International de Recherche en Infectiologie, (Team Epidermal Immunity and Allergy); INSERM, U1111; Univ Lyon; Université de Lyon 1; École Normale Supérieure de Lyon; CNRS, UMR 5308, Lyon, France, Department of Allergology and Immunology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Paloma García-Piqueras
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Abstract
PURPOSE OF THE ARTICLE Psoriasis is a chronic, immune-mediated, skin disease with a significantly negative impact on patients' quality of life. Moderate-to-severe disease often requires systemic therapies and currently available ones still have numerous disadvantages or limitations. Tyrosine kinase 2 (TYK2) mediates immune signaling of IL-12, IL-23, and type I interferons, without interfering with other critical systemic functions. This article aims to review the current knowledge on deucravacitinib, a new oral drug which selectively inhibits TYK2, granting it a low risk of off-target effects. MATERIALS AND METHODS A review of the published literature was conducted using the PubMed database, published abstracts and virtual presentations from scientific meetings, data from industry press releases, and results published on ClinicalTrials.gov regarding the deucravacitinib for the treatment of psoriasis. Manuscripts with trial results, case series, clinical trial data from ClinicalTrials.gov, and articles highlighting expert perspectives on the topic of the article were selected. RESULTS Two phase 3, 52-week trials evaluated deucravacitinib 6 mg against placebo and apremilast - POETYK PSO-1 and PSO-2, enrolling 1688 patients with moderate-to-severe psoriasis. At week 16, over 50% of patients treated with deucravacitinib reached PASI75, significantly superior to placebo and apremilast. Symptomatic improvement was also reported, with greater impact on itch. Deucravacitinib was well tolerated and safe. There were no reports of serious infections, thromboembolic events, or laboratory abnormalities. Persistent efficacy and consistent safety profiles were reported for up to 2 years. CONCLUSIONS Deucravacitinib has the potential to become a safe, effective, and well-tolerated treatment for patients with moderate-to-severe disease. Future studies will be important to determine the exact role of this drug in the treatment of psoriasis.
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Affiliation(s)
- Tomás Estevinho
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Ana Maria Lé
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Tiago Torres
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.,Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Lé AM, Gooderham M, Torres T. Abrocitinib for the treatment of atopic dermatitis. Immunotherapy 2023; 15:1351-1362. [PMID: 37667972 DOI: 10.2217/imt-2023-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
Abrocitinib is an oral small molecule which selectively inhibits JAK1, modulating multiple cytokine pathways involved in atopic dermatitis. Both abrocitinib 200 mg and 100 mg reached efficacy results comparable to dupilumab and superior to placebo. Abrocitinib 200 mg was superior to dupilumab in some trials, consistently providing a faster response and itch relief from week 2 to 26. Continuous abrocitinib 200 mg is the most effective at controlling this disease, but with an induction-maintenance approach with abrocitinib 200 mg followed by 100 mg, over 55% of patients did not flare for 40 weeks. Abrocitinib common adverse effects are nonserious. A self-limited dose-related decrease in platelet counts was consistently observed, without clinical repercussion. Abrocitinib demonstrated high efficacy and a favorable safety profile.
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Affiliation(s)
- Ana Maria Lé
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, 4000-001, Portugal
| | - Melinda Gooderham
- SkiN Centre for Dermatology, Queen's University and Probity Medical Research, Peterborough, ON, K9J 5K2, Canada
| | - Tiago Torres
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, 4000-001, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
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Dege T, Chircop I, Lé AM, Byrne N, Garcia-Piqueras P, Rosell-Díaz ÁM, Reynaud V. Journal Club: Update on pyoderma gangrenosum. Eur J Dermatol 2023; 33:569-572. [PMID: 38297942 DOI: 10.1684/ejd.2023.4587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Tassilo Dege
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Inès Chircop
- CIRI, Centre International de Recherche en Infectiologie, (Team Epidermal Immunity and Allergy); INSERM, U1111; Univ Lyon; Université de Lyon 1; École Normale Supérieure de Lyon; CNRS, UMR 5308, Lyon, France, Department of Dermatology, Hôpital Edouard Herriot, Lyon, France
| | - Ana Maria Lé
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Niamh Byrne
- Department of Dermatology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Paloma Garcia-Piqueras
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Victoire Reynaud
- CIRI, Centre International de Recherche en Infectiologie, (Team Epidermal Immunity and Allergy); INSERM, U1111; Univ Lyon; Université de Lyon 1; École Normale Supérieure de Lyon; CNRS, UMR 5308, Lyon, France, Department of Allergology and Immunology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
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Lé AM, Nogueira M, Araújo A, Horta M. Vismodegib treatment for recurrent basal cell carcinoma - a successful case report. Eur J Dermatol 2023; 33:332-333. [PMID: 37594358 DOI: 10.1684/ejd.2023.4508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
- Ana Maria Lé
- Dermatology Department, Centro Hospitalar e Universitário de Santo António, Portugal
| | - Miguel Nogueira
- Dermatology Department, Centro Hospitalar e Universitário de Santo António, Portugal
| | - Alexandra Araújo
- Oncology Department, Centro Hospitalar e Universitário de Santo António, Portugal
| | - Miguel Horta
- Dermatology Department, Centro Hospitalar e Universitário de Santo António, Portugal
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Chircop I, Lé AM, Dege T, Byrne N, Garcia-Piqueras P, Rosell-Díaz ÁM, Reynaud V. Journal club: Recent therapeutic developments in the management of chronic spontaneous urticaria. Eur J Dermatol 2023; 33:326-329. [PMID: 37594356 DOI: 10.1684/ejd.2023.4506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
- Inès Chircop
- Department of Dermatology, Hôpital Edouard Herriot, Lyon, France, CIRI, Centre International de Recherche en Infectiologie, (Team Epidermal Immunity and Allergy); INSERM, U1111; Univ Lyon; Université de Lyon 1; École Normale Supérieure de Lyon; CNRS, UMR 5308, Lyon, France
| | - Ana Maria Lé
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Tassilo Dege
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Niamh Byrne
- Department of Dermatology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Paloma Garcia-Piqueras
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Victoire Reynaud
- CIRI, Centre International de Recherche en Infectiologie, (Team Epidermal Immunity and Allergy); INSERM, U1111; Univ Lyon; Université de Lyon 1; École Normale Supérieure de Lyon; CNRS, UMR 5308, Lyon, France, Department of Allergology and Immunology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
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Martins A, Lé AM, Torres T. Deucravacitinib for the treatment of psoriatic arthritis: the evidence so far. Drugs Context 2023; 12:dic-2023-2-7. [PMID: 37168876 PMCID: PMC10166261 DOI: 10.7573/dic.2023-2-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/23/2023] [Indexed: 05/13/2023] Open
Abstract
Psoriatic arthritis (PsA) is a heterogeneous disease that may develop in up to 30% of patients with psoriasis. PsA mainly involves peripheral joints; however, axial skeleton and entheses can also be involved. PsA is the result of a complex interplay between an individual's genotype and environmental factors that triggers an immune response and leads to the production of a cytokine cascade. Even though there are about 17 targeted therapies for PsA, a significant percentage of patients fail to respond to such treatments, have a partial response or develop side-effects. This article aims to review the current knowledge on deucravacitinib, a new oral small molecule that selectively inhibits tyrosine kinase 2 (TYK2), for the treatment of PsA. TYK2, a member of the Janus kinase (JAK) family, is responsible for mediating intracellular signalling of cytokines involved in the pathogenesis of PsA and psoriasis, namely IL-12, IL-23, and type I interferons. Recently, deucravacitinib was approved by the FDA for the treatment of moderate-to-severe plaque psoriasis and is currently being evaluated in phase III clinical trials in PsA. In a phase II clinical trial, deucravacitinib showed sustained effectiveness in several domains of PsA, namely arthritis, enthesitis and dactylitis, was well tolerated, and had a favourable safety profile. In patients with psoriasis, deucravacitinib had shown a higher efficacy than placebo and apremilast. Deucravacitinib is a promising therapy, with a unique mechanism of action. Results from the phase III programme and studies evaluating long-term response and head-to-head comparisons with other targeted agents will be important to establishing the position of deucravacitinib in the management of PsA.
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Affiliation(s)
- Ana Martins
- Department of Rheumatology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Ana Maria Lé
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Tiago Torres
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
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Abstract
Psoriasis is an immune-mediated disease, with the interleukin (IL)-23/IL-17 axis currently considered its main pathogenic pathway. Tyrosine kinase 2 (TYK2) is responsible for mediating immune signalling of IL-12, IL-23 and type I interferons, without interfering with other critical systemic functions as other JAK proteins do. This article aims to review the current knowledge on deucravacitinib, a new oral drug that selectively inhibits TYK2, granting it a low risk of off-target effects. After good efficacy and safety results in a phase II, placebo-controlled trial, two phase III, 52-week trials evaluated deucravacitinib 6 mg against placebo and apremilast—an active comparator. POETYK PSO-1 and PSO-2 involved 1688 patients with moderate-to-severe psoriasis. After 16 weeks, in both studies, over 50% of patients treated with deucravacitinib reached PASI75, which was significantly superior to placebo and apremilast. In POETYK PSO-1, these results improved until week 24 and were maintained through week 52, with over 65% of patients achieving PASI75 at this point. A reduction in signs and symptoms was also reported by patients, with greater impact on itch. Deucravacitinib was well tolerated and safe. There were no reports of serious infections, thromboembolic events, or laboratory abnormalities, which are a concern among other JAK inhibitors. Persistent efficacy and consistent safety profiles were reported for up to 2 years. Despite advances in the treatment of psoriasis, namely among biologic agents, an oral, effective and safe new drug can bring several advantages to prescribers and patients. Further investigation is required to understand where to place deucravacitinib among current psoriasis treatment options.
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Affiliation(s)
- Ana Maria Lé
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Tiago Torres
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal. .,Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
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Abstract
Generalized pustular psoriasis (GPP) is a rare yet severe variant of psoriasis, characterized by the eruption of superficial sterile pustules that appear suddenly and widely distributed, potentially life-threatening. It more commonly presents through recurrent acute flares triggered by stress, corticosteroid withdrawals, pregnancy, or infections. The pathogenesis of this disease is yet to be fully understood. Nevertheless, studies have suggested an important role of an IL-1 subfamily of cytokines, due to an imbalance of the IL-36 axis favoring of pro-inflammatory activity. The therapeutic intervention for this condition is still a challenge as its rarity and scarce available information contribute to the absence of specific treatment. Current options stand on small, open-label trials or follows standard treatment for plaque psoriasis. Spesolimab and imsidolimab are two IL-36 receptor inhibitors which completed phase 1 and 2 trials with a good efficacy and safety profile in the treatment of this disease, including in the fast control of its acute flares. The most common adverse events reported with spesolimab were mild to moderate infections, and imsidolimab was well tolerated. GPP clinical trials remain to have their small sample size as a major limitation, but IL-36 receptor inhibitors are promising therapeutic options currently under investigation.
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Affiliation(s)
| | - Ana Maria Lé
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Tiago Torres
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.,Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Abstract
Psoriasis is a chronic immune-mediated skin disease with a significant impact on patients' quality of life. Mild-to-moderate forms of the disease usually require long-term topical treatment, but prolonged use of corticosteroids and vitamin D analogues is limited by adverse effects. With further understanding of psoriasis pathogenesis, new molecules are emerging aiming to fulfil these clinical needs. Tapinarof, an aryl hydrocarbon receptor modulator, has completed a phase III study and demonstrated good efficacy results, even in long treatment courses, with a favourable safety profile. It additionally appears to have a promising remitting effect as patients presented with an average relapsing time of over 3 months. Roflumilast, a phosphodiesterase type 4 inhibitor, also underwent a phase III study with significant lesion improvement and notable pruritus management, and with no reported side effects. Roflumilast was evaluated as an option for intertriginous areas with good outcomes in a small sample, but larger trials are required. The Janus kinase-signal transducer and activator of transcription pathway has been targeted in recent clinical investigations with promising options, currently with brepocitinib pending phase IIb results. Ongoing preclinical studies involving interleukin-2 inhibition, RNA modulators and amygdalin analogues may lead to forthcoming clinical trials. New topical drugs are successfully emerging and future research comparing them to classical options will dictate their clinical role in the treatment of psoriasis.
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